An ADH provider shall not:

1. (A) with the knowledge that a member is enrolled in a Capitated Program, engage in any practice that would reasonably be expected to have the effect of steering or encouraging the member to disenroll from the Capitated Program in order to retain the ADH provider to provide ADH services on a fee-for-service basis; or
2. (B) offer to a member, or his or her family or caregivers, in-person or through marketing any inducement to retain the ADH provider to provide ADH services, such as a financial incentive, reward, gift, meal, discount, rebate, giveaway, or special opportunity;
3. (C) pay a “finder’s fee” to any third-party in exchange for referring a member to the ADH provider; or
4. (D) engage in any Unfair or Deceptive Acts or Practices in connection with any Marketing.

REGULATORY AUTHORITY

130 CMR 404.000: M.G.L. c. 118E, §§ 7 and 12.

Commonwealth of Massachusetts Subchapter Number and Title Page

MassHealth 4. Program Regulations

4-14

Provider Manual Series (130 CMR 404.000)

Transmittal Letter Date

Adult Day Health Manual

ADH-26 07/27/18

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